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Relapse

Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant

Bone Marrow Transplantation volume 34, pages 721–727 (2004)Cite this article

Summary:

Treatment options for persons with leukemia relapsing after allogeneic transplantation are limited. We analyzed the outcome of 279 patients with acute and chronic leukemia, who relapsed after HLA-identical sibling transplantation and received a second allogeneic transplant. The influence of potential risk factors on treatment-related mortality (TRM), relapse, treatment failure (relapse or death) and overall survival after second transplantation were assessed using proportional-hazards regression. The cumulative incidences (95% confidence interval) of relapse and TRM at 5 years were 42 (36–48)% and 30 (24–36)%, respectively. The 5-year probabilities of both overall and leukemia-free survival were 28 (23–34)%. In multivariate analyses, risks of treatment failure and mortality were lower in younger patients (⩽20 years) and patients who relapsed after 6 months from first transplantation. Risks of relapse were lower in patients who relapsed after 6 months from first transplantation and in complete remission prior to second transplantation. Risks of relapse were higher after reduced-intensity conditioning regimens. Any potential advantage of using a different matched related donor for a second transplantation is not supported by these data. Although age, disease status and conditioning regimen are important, duration of remission after first transplantation appear to be the most important determinant of outcome.

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Acknowledgements

This work was supported by a Clinical Research Career Development Award from the American Society of Clinical Oncology (ME), Public Health Service Grant U24-CA76518 from the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, the National Heart, Lung and Blood Institute and the Cancer Center, Medical College of Wisconsin.

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Authors and Affiliations

  1. International Bone Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee, WI, USA

    M Eapen, M M Horowitz, J P Klein, M-J Zhang & C N Bredeson

  2. MD Anderson Cancer Center, Houston, TX, USA

    S A Giralt, R E Champlin & M deLima

  3. University of Minnesota, Minneapolis, MN, USA

    J E Wagner

  4. Northwestern University Medical School, Chicago, IL, USA

    M S Tallman

  5. Bristol Children's Hospital, Bristol, UK

    D I Marks

  6. Medical College of Wisconsin, Milwaukee, WI, USA

    B M Camitta

  7. Huddinge University Hospital, Huddinge, Sweden

    O Ringdén

  8. Hospital San Creu I Sant Pau, Barcelona, Spain

    R Martino

  9. Center for Advanced Studies in Leukemia, Los Angeles, CA, USA

    R P Gale

  10. Columbia University, New York, NY, USA

    M S Cairo

  11. Mayo Clinic Rochester, Rochester, MN, USA

    M R Litzow

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  1. M Eapen
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Correspondence to M Eapen.

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Eapen, M., Giralt, S., Horowitz, M. et al. Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant. Bone Marrow Transplant 34, 721–727 (2004). https://doi.org/10.1038/sj.bmt.1704645

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